Learning Objectives:

On completion of this lecture discussion,

the learner will be able to:
✓ Describe the structures and functions of
the upper and lower respiratory tracts.
✓ Use assessment parameters appropriate
for determining the characteristics and
severity of the major symptoms of
respiratory dysfunction.
✓ Identify the nursing implications of
procedures used for diagnostic evaluation
of respiratory function.
The Respiratory System
 The respiratory system is composed of
the upper and lower respiratory
tract.
 These two tracts are responsible for
ventilation
 The upper respiratory tract, known as
the upper airway, warms and filters
inspired air so that the lower
respiratory tract (the lungs) can
accomplish gas exchange.
➢ Gas exchange involves delivering O2 to
the tissues through the bloodstream
and expelling waste gases, such as
CO2, during expiration
The
Respiratory
System
 Upper Respiratory Tract
1. Nose
2. Sinuses
3. Nasal passages
4. Pharynx
5. Tonsils
6. Adenoids
7. Larynx
8. Trachea
 Lower Respiratory Tract
1. Lungs
Anatomy of the Upper Respiratory Tract
Nose
 Responsible for
 Serves as a passageway olfaction (smell)
for air to pass to and because the
from the lungs. olfactory receptors
 Filters impurities & are located in the
humidifies and nasal mucosa.
warms the air
as it is inhaled.
Paranasal Sinuses
 Include 4 pairs of bony cavities that are
lined with nasal mucosa and ciliated
pseudostratified columnar epithelium.
These air spaces are connected by a series
of ducts that drain into the nasal cavity.
 Are named by their location.
 Serve as a resonating chamber in
speech;
 A common site of infection.
Turbinate Bones (Conchae)
 Also called conchae (shell like appearance)
 Air entering the nostrils is deflected upward to the
roof of the nose and it follows a circuitous route
before it reaches the nasopharynx. It comes in
contact with a large surface of moist, warm mucous
membrane that catches practically all dust and
organisms in the inhaled air. Air is moistened,
warmed to body temperature, and brought
into contact with sensitive nerves. Some nerves
detect odors; others provoke sneezing to expel
irritating dust.
Pharynx
 Or throat, is a tubelike structure that connects
that nasal and oral cavities to the larynx.
 Functions as a passageway from the respiratory
and digestive tracts.
 Divided into 3 regions:
1. Nasopharynx – located posterior to the nose
and above the soft palate.
2. Oropharynx – houses the faucial or palatine
tonsils.
3. Laryngopharynx – extends
from the hyoid bone to the
cricoid cartilage.
 The epiglottis forms the
entrance of the larynx.
Tonsils, Adenoids
 Or pharyngeal tonsils are located in the roof of
the nasopharynx.
 The tonsils and the adenoids and other
lymphoid tissue encircle the throat. These
structures are important links in the chain of
lymph nodes guarding the body from
invasion by organisms entering the nose
and the throat.
Larynx
 Or voice organ is a cartilaginous epithelium
lined structure that connects the pharynx and
the trachea.
 Major function is vocalization; refered to as
the voice box.
 Protects the lower airway from foreign
substances and facilitates coughing.
 Consists of the following:
 Epiglottis – a valve flap that covers the
opening to the larynx during swallowing.
 Glottis – opening between the vocal
cords in the larynx.
 Thyroid cartilage – the largest of the
cartilage structures; part of it forms the
Adam’s apple.
 Cricoid cartilage – is the only complete
cartilaginous ring in the larynx.
 Arytenoid cartilages – used in vocal cord
movement with the thyroid cartilage.
 Vocal cords – ligaments controlled by
muscular movements that produce
sounds. Located at the lumen of the
larynx.
Trachea
 Or windpipe is
composed of
smooth muscles
with C-shaped
rings of cartilage
at regular
intervals. The
cartilaginaous
rings are
incomplete on the
posterior suface
and give firmness
to the wall of the
trachea,
preventing it from
collapsing.
 Serves as the
passage between
the larynx and the
bronchi.
Anatomy of the Lower Respiratory Tract
Lungs
 Are paired elastic structures enclosed in the
thoracic cage, which is an airtight chamber with
distensible walls.
Pleurae
 Refer to the serous membrane that line the
lungs and wall of the thorax.
 2 pleurae:
1. Visceral pleura – covers the outer surface
of the lungs;
2. Parietal pleura – covers the internal surface
of the thoracic cavity.
Pleural cavity –
space between
the visceral and
parietal pleura.
➢ It contains a
small amount
of pleural fluid
that serve to
lubricate the
thorax and
lungs and
permit
smooth
motion of the
lungs within
the thoracic
cavity with
each breath.
Mediastinum
 Is in the middle
of the thorax,
between the
pleural sacs that
contain the two
lungs. It extends
from the sternum
to the vertebral
column and
contains the
thoracic tissue
outside the lungs.
Lobes
 Each lung is
divided into
lobes. The left
lung 2lobes.
While the right
lung on the
other hand
consists of 3
lobes.
Bronchi and Bronchioles
 There are several
divisions of the bronchi
within each lobe of the
lung.
 Lobar bronchi (three
in the right lung and
two in the left lung).
○ Lobar bronchi divide
into segmental
bronchi (10 on the
right and 8 on the
left).
 Segmental bronchi
then divide into
subsegmental
bronchi which
then divide into
bronchioles.
 Bronchioles
branch into
terminal
bronchioles
which then
become
respiratory
bronchioles
which then lead
into alveolar
ducts and
alveolar sacs
then alveoli.
Alveoli
 The lung is made up of
300 million alveoli,
which are arranged into
clusters of 15-20.
 3 types of alveolar cells:
 Type I – epithelial cells
that form alveolar
walls.
 Type II – metabolically
active; secrete
surfactant that lines
the inner surface and
prevents alveolar
collapse.
 Type III – large
phagocytic cells that
ingest foreign
matter & act as an
important defense
mechanism.
Respiration
Respiration
Common Signs & Symptoms
 The major signs and symptoms of
respiratory disease are dyspnea, cough,
sputum production, chest pain, wheezing,
clubbing of the fingers, hemoptysis and
cyanosis.
 These clinical manifestations are related to
the duration and severity of the disease.
Dyspnea
 (difficult or labored breathing, shortness
of breath) Is a symptom common to many
pulmonary and cardiac disorders,
particularly when there is decreased lung
compliance or increased airway resistance.
 Management of dyspnea is aimed at
identifying and correcting cause. Relief of
the symptom sometimes is achieved by
placing the patient at rest with the head
elevated and in severe cases,
administering O2.
Cough
 Results from irritation of the mucous
membranes anywhere in the respiratory
tract. The stimulus producing a cough may
arise from an infectious process or from an
airbone irritant such as smoke, smog, dust,
or gas. Cough is the patient’s chief
protection against the accumulation of
secretions in the bronchi and bronchioles.
Sputum production
 A patient who coughs long enough almost
invariably produces sputum. Violent coughing
causes bronchial spasm, obstruction, and further
irritation of the bronchi and may result in
syncope. A severe, repeated, or uncontrolled
cough that is non-productive is exhausting and
potentially harmful. Sputum production is the
reaction of the lungs to any constantly recurring
irritant.
 Management:
 Increase OFI
 Discourage smoking
 Encourage adequate oral hygiene
 Encourage to drink citrus juices at the
beginning of the meal
Chest pain or discomfort
 may be associated with pulmonary or
cardiac disease. Chest pain associated with
pulmonary conditions may be sharp,
stabbing, and intermittent, or it may be
dull, aching, and perstistent. The pain is
usaually felt on the side where the
pathologic process is located, but it may
be referred elsewhere – ex. To the neck,
back and abdomen.
 Analgesic medications may be effective in
relieving chest pain but care must be
taken not to depress the respiratory center
or a productive cough, if present. A
regional anesthetic block may be
performed to relieve extreme pain.
Wheezing
 It is heard with or without a stethoscope, depending
on its location. Wheezing is a high pitched, musical
sound heard mainly on expiration.
 Oral or inhalant bronchodilator medications reverse
wheezing in most instances.
Clubbing of Fingers
 Is a sign of lung disease found in patients with
chronic hypoxic conditions, chronic lung infections,
and malignancies of the lung. This finding may be
manifested initially as sponginess of the nailbed
and loss of the nailbed angle.
Hemoptysis
 Is the expectoration of blood from the
respiratory tract; is a symptom of both
pulmonary and cardiac disorder. It may be
sudden and it may be intermittent or
continuous.
 To determine the cause: chest x-ray,
angiography and bronchoscopy.
Cyanosis
 A bluish coloring of the skin; is a very late
indicator of hypoxia.
 An anemic patient rarely manifests cyanosis,
and a polycythemic patient may appear
cyanotic even if adequately oxygenated.
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